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Daugaard Proposes Wrong-Headed Work Requirement for Medicaid

Among the few policy initiatives in a mostly retroflective State of the State Address yesterday, Governor Dennis Daugaard embraced a cranky Trump proposal to impose a work requirement on some Medicaid recipients.

Most South Dakotans receiving Medicaid can’t be forced to work:

South Dakotans on Medicaid—slide from Gov. Dennis Daugaard, State of the State Address, Pierre, SD, 2018.01.09.
South Dakotans on Medicaid—slide from Gov. Dennis Daugaard, State of the State Address, Pierre, SD, 2018.01.09.

About 120,000 South Dakotans—maybe 13% of our population—receive Medicaid. About 68% of those recipients are children (almost 4 in 10 South Dakota kids). Nearly 20% of our Medicaid recipients are aged, blind, or disabled. 1% are pregnant women. Less than 11% are low-income parents who could—or in pushy conservative parlance, should—be working.

Governor Daugaard doesn’t want to force all of those low-income parents to get jobs. He wants to target an estimated 4,500 of those recipients—less than 4% of Medicaid enrollees—who are not caring for children under age 1. He proposes pilot programs in Minnehaha and Pennington counties, where, supposedly, it should be easiest for targeted Medicaid enrollees to find work. He also mentioned offering premium support and child care to help those parents keep their jobs.

The Trump Administration has bleated some Newspeak about ending the “soft bigotry” of the social programs of the Obama Administration. Yet Governor Daugaard appears to justify his work demand with some hard assumptions of his own about Medicaid recipients:

“Work is an important part of personal fulfillment,” Daugaard said. “By making this adjustment to our Medicaid program, we can continue to help those who need it the most and start to connect those who can work with jobs that give them that sense of self-worth and accomplishment” [James Nord, “Daugaard: South Dakota Seeking Medicaid Work Requirement,” AP via McClatchy, 2018.01.09].

Daugaard here assumes that poor people between jobs lack a sense of self-worth and accomplishment. He also assumes that any old job will provide a sense of self-worth and accomplishment. Both assumptions are fallacious. There are other sources of self-worth and accomplishment. There are also jobs (especially jobs forced upon workers) that erode one’s sense of self-worth and accomplishment.

Instead of degrading the poor, South Dakota should focus on the main objective of Medicaid—making sure Americans get health care. Requiring work does not do that—after all, there are apparently thousands of South Dakotans with jobs who still get Medicaid, and there are thousands more who have jobs but can’t afford private insurance whom we could cover if we expanded Medicaid under the Affordable Care Act. The extraneity of work requirements to Medicaid’s main objective could get the Daugaard/Trump plan canned in court:

Liberal groups are preparing to sue the administration over the changes, arguing that work requirements are not allowed under current law and would require congressional action. Waivers must promote the “objectives” of Medicaid to be approved under the law, and Democrats argue a change that could cause people to lose coverage fails that standard.

“The guidance is an attempt to put the administration’s preferred legal framing around the waiver approvals, in anticipation of likely legal challenge in the federal courts,” Fishman, who now works for Families USA, a liberal advocacy group, wrote in the email. “Given that the legal standard is whether the waivers ‘promote the objectives’ of the Medicaid program, that the basic objective of the program is to cover low-income people, and that these waivers will take coverage away from low-income people, they will have a tough legal case to make” [Peter Sullivan, “Trump Poised to Take Action on Medicaid Work Requirements,” The Hill, 2018.01.05].

Instead of looking for ways to kick people out of public health coverage, South Dakota should focus on making sure every South Dakotan, men women, and children, can afford to go to the clinic or the hospital and get well. Help people get healthy and stay healthy, and they’ll feel better about themselves and about getting up and going to work.


  1. owen reitzel 2018-01-10

    Once again I totally agree with you Cory. The Republicans seem to have the firm belief that people on Welfare or on Medicaid are bums. I guess the kids are as well.
    Sadly these people also think of themselves as good Christians.
    Catch Rep. Nancy York’s statement on the link below at the 1:25 mark. I bet she’s had a pretty easy life. Maybe I’m wrong.

  2. o 2018-01-10

    If fortunate enough to be a wealthy individual or corporation, our government cannot lavish funds quickly enough with no moral compunction or reservation; if truly in need, every government penny is only begrudgingly doled with a fight and denigration.

  3. Donald Pay 2018-01-10

    I have a different perspective on this, Cory. I agree with Daugaard that work is important to encourage. Nearly all adults and many teenagers want to work, or do some sort of constructive activity that improves themselves and society.

    I’ve spent a lot of time working with people who have great difficulties finding and keeping work. Many of those doing the hiring view these folks as inferior and noncompetitive. If you were dumb and stupid once and got arrested and convicted, you can almost be assured you will be passed over repeatedly. Take away the ability to discriminate against people with past criminal convictions and you solve some of the problem.

    People get turned down for employment because of lots of reasons not having to do with their skill levels. Job discrimination is rampant. When it comes to skills, it used to be that employers would take the time to develop skills in people, train them up for the jobs that needed doing. Now employers expect the state to foot the bill for that. Maybe it’s time to require employers to step up, especially those getting state assistance.

    Some folks can’t work 8 hours because of physical or mental problems or scheduling, but they could do 2 or 3 hours a day. Flexibility is key to getting some of these people a foot in the door. Once they get a taste for work, they tend to want more hours.

    We should do everything we can do to help people get work, keep them on the job and move them up the ladder of success, but what is the state doing to encourage that? Do they hire the people they are demanding get jobs. Are they requiring those businesses that are on state economic development aid to hire some people off the aid rolls. Why is it that Daugaard, who has a lot of power to hire these folks, always wants to punish and blame rather than be a part of the solution himself.

    Maybe Daugaard should set some goals for the state to hire the people he seems to think should be working.

    I had to go into businesses to present information about hiring people who may have seemed not competitive. A number of businesses wanted to be part of the solution. Is Daugaard heading up any effort to encourage businesses to hire these folks?

    It’s also important to follow the law. Daugaard’s plan is illegal. He could do a lot to help people get work. Instead he seems more interested in talking points that have no impact.

  4. Loren 2018-01-10

    I long for the days, before Saint Ronald Reagan and his “welfare queen” propaganda, when Republicans actually looked at facts rather than using talking points, slogans and bumper stickers!

  5. Donald Pay 2018-01-10

    Now, here’s another thing. A lot, probably most, of those low-income folks on Medicaid are already working, but at businesses, like Walmart, that purposely manipulate hours so as to keep those workers off employer-based benefits, like health care. Maybe the state should hammer those businesses with a requirement to provide health coverage to all workers, so they wouldn’t have to be on Medicaid.

  6. o 2018-01-10

    The divestment of business from workers is being seen in public health care costs. People who hold several part-time jobs still do not qualify for employer health care benefits (as Donald notes above). It is not a question of work, it is a question of compensation.

    The bigger explosion will be as we see the wave of retirees who have been moved from employer pension systems to 401K/defined benefit individual retirement investments reach retirement age. Retiring Americans are not financially prepared to retire, and as such their health costs will become a larger responsibility to the state. Business’ grab for profit has again shifted costs to the taxpayer. Is the answer to keep them working (in perpetuity) as well?

  7. Donald Pay 2018-01-10

    And here’s another beef. South Dakota refused to expand Medicaid under the ACA to actually make sure people who had a job (or two or three) could have health coverage through Medicaid. Yeah, that shows just how much South Dakota government really values work. Daugaard has a lot of improvements to make in how he encourages work.

  8. Debbie 2018-01-10

    Democrats need to start paying attention if they want to start making intelligent talking points.

    While I agree that Dennis’s plan is ridiculous, Democrats need to learn the real reason behind this sudden move, right now Democrats are helping him.

    If you want to change the beast learn why the beast is attacking, its much more devious than just throwing people off of Medicaid.
    I could make it easy and tell you, but you need to stop watching so much TV and start paying attention to your money or just keep trying to attack Republicans with weak arguments.

  9. o 2018-01-10

    Debbie knows something I don’t. (But will not tell.)

    btw, this is not a sudden move.

  10. Cory Allen Heidelberger Post author | 2018-01-11

    Debbie, I don’t watch TV. We don’t have cable.

    Don’t play coy—if you can help, help. We’re all up front here.

  11. Cory Allen Heidelberger Post author | 2018-01-11

    Donald offers some solid thoughts. We all agree work is important. We all want to encourage work. But doing it through Medicaid is the wrong way to do it. Daugaard’s own initiative addresses less than 4% of the people in the program, which suggests that either (1) Medicaid doesn’t reach many of the lazy bums who allegedly need the state to teach them the importance of work or (2) there aren’t enough lazy bums to warrant this supposedly big policy initiative.

    Donald does a good job of explaining that a lot of people who may not be working aren’t lazy or in need of our encouragement but rather are kept out of the work they want by discrimination. I love the suggestion that, if there is some merit to pairing this social service with a work requirement, we should couple it with our corporate welfare program: if you are one of the many companies Daugaard bragged about in his State of the State Address who get state government subsidies, you will be required to provide the work that we are requiring able-bodied Medicaid recipients to do.

    Donald also makes a great point about the folks who do have jobs but still qualify for Medicaid. That’s really corporate welfare, as the public picks up the health care tab for Walmart stockers and greeters who ought to qualify for employer benefits but get ripped off by the erratic scheduling practices. Those erratic scheduling practices also make it hard for those hard-working South Dakotans to supplement their income with second jobs.

    Gee, maybe the problem isn’t the Medicaid recipients at all. Maybe the desire to work is far more widespread among the poor than Republicans lead us to believe. Maybe the real problem keeps coming back to the rich corporations who keep exploiting the poor and swindling the taxpayers.

  12. Donald Pay 2018-01-11

    Cory, Daddy Daugaard’s approach just adds one more issue people have to deal with, and is an impediment to people getting a job.

    There are a lot of impediments to getting a job, so I think it’s fine to use Medicaid sign up to offer assistance in finding a job or getting a better one. The more you can one-stop shop for aid and a job at the same time just helps uncomplicate the process. But you have to provide real help, and I don’t see anything in Daugaard’s proposal that deals with help in resume writing, job searching, applying, practice interviews, sometimes providing decent clothes to wear to an interview.

    Most job apps now are on-line with and are difficult to complete, especially if you have no computer and limited computer skills. The larger companies, like Home Deport, Target, etc., have screening tests that are long and involved and use algorithms to screen out people. I’ve even done tests for applicants, because, really, all this stuff should be illegal, but some Republican probably gets paid lots of money to fool companies that this is a great way to screen people, rather than having, you know, a real live person do it. People get discouraged just trying to fill out the damn app and take the screening test. They want college grads to stock their damn shelves!!! You can’t just go in, talk to someone and get hired that day anymore in America.

  13. Cory Allen Heidelberger Post author | 2018-01-11

    “one-stop shop”—that’s a good way to think of the ideal social services office. I like the idea that the work requirement could be administered as a way to get people jobs who suffering the kind of discrimination, subtle and gross, that you describe. Imagine it: Joe is down on his luck. He comes in for Medicaid assistance (or maybe some one-stop-shop public servant reaches out through some other office to let him know he’s eligible for assistance). The social services office says, “We’ll pay for your medical coverage, and we’ll do you one better. We have three jobs you can walk into this afternoon and start earning a paycheck at.” Joe takes one of those jobs—maybe through a private firm partnering with DSS, maybe a job for the state itself. He works it for a year… and then, son of a gun, he’s got steady employment back on his résumé. For as long as Joe is on Medicaid (and maybe beyond), DSS keeps Joe’s name in a database and does ongoing job-hunting for him. When Job Service receives an opening that fits Joe’s skills and pays better than what he’s doing now, DSS checks with Joe, then calls that employer and says, “We have someone who can fill that job for you this week. Call him.” That employer calls Joe and, with the state vouching for him, offers Joe the job on the spot. How’s that for removing barriers to employment?

    The 4% of recipients this program addresses feels like margin of error. NPR this afternoon said states will need to go a big list of exemptions to make sure they aren’t imposing the work requirement on someone who is disabled or otherwise shouldn’t be required to work. Will it be worth that extra effort?

  14. Debbie 2018-01-12

    You also don’t pay attention to economics apparently and it’s not about removing barriers to employment . Of course it’s not sudden and it’s not a just a Republican move either, we were hearing about this in 2015 and 2016. No the state is not going to do job hunting either that would defeat the purpose of this work requirement. It will most likely be run the same way as ADFC you prove that you are in some job training or vounteering and you get one week a month to job hunt with proof from employers that you are actually putting in applications.

  15. Cory Allen Heidelberger Post author | 2018-01-13

    So Donald’s mistaken? Some significant portion of the Medicaid recipients we’re talking about here don’t face barriers to employment?

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